切割的球囊预扩张对支架置入后再狭窄的影响

目的 :探讨切割的球囊预扩张对支架内再狭窄的影响。方法 :86例Multilinkstent置入患者 ,按预扩张所用球囊不同 ,分为切割的球囊血管成形术 (CBA)组和单纯球囊血管成形术 (POBA)组 ,比较两组支架置入后即刻及远期血管造影随访结果。结果 :治疗后即刻及追踪造影结果显示 ,两组在最小血管径 (MLD)、狭窄度(DS)、晚期内径丢失方面无明显差别 ,内径丢失指数CBA组 (0 .2 8± 0 .15 )较POBA组 (0 .4 2± 0 .2 8)为低 (P <0 .0 5 ) ,再狭窄率CBA组为 15 .4 % ,POBA组为 2 5 .0 % ,CBA组呈低的倾向。结论 :CBA预扩张有可能对支架内再狭窄产生有益影响 ,值得进一步探讨     

切割球囊对冠状动脉支架内再狭窄的近期及远期疗效

目的　比较切割球囊成形术 (CBA)与普通球囊成形术 (POBA) ,对支架内再狭窄病变的近、远期血管造影结果 ,评价CBA对支架内再狭窄病变的有效性。方法　 16 6例支架内再狭窄PTCA病人 ,按所用球囊不同 ,分为CBA组 (98例 ) ,POBA组 (6 8例 ) ,分别比较术后即刻及远期定量冠脉造影最小血管径 (MLD)、狭窄度及再狭窄率。结果　术后即刻MLD及狭窄度两组差别无显著性 ,CBA组最大扩张压明显为低 [(8 3± 0 9)atm比 (14 7± 4 6 )atm ,P <0 0 5 ]。追踪造影结果 ,CBA组MLD明显大于POBA组 [(1 7± 0 5 )mm比 (1 4± 0 5 )mm ,P <0 0 5 ]、狭窄度明显小于POBA组 [(36± 13) %比(46± 15 ) %,P <0 0 1],再狭窄率低于POBA组 (2 6 1%比 4 0 3%,P <0 0 5 )。结论　CBA的低压扩张效果在支架内再狭窄病变亦是有效的 ,并且获得了较POBA低的再狭窄率 ,值得进一步探讨总结。     

切割球囊和普通球囊治疗冠状动脉支架内再狭窄有效性和安全性的Meta分析

目的　评价切割球囊血管成形术（CBA）和普通球囊血管成形术（POBA）治疗冠状动脉支架内再狭窄的有效性和安全性。方法　计算机检索Cochrane图书馆临床对照试验资料库（CCTR）、Pubmed、Embase、万方数据库、中国学术期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）、维普数据库（VIP）,检索文章时间为各大数据库建库至2013年6月。收集CBA和POBA治疗冠状动脉支架内再狭窄的随机对照试验资料,共纳入7个随机对照试验,960例患者,其中CBA组493例,POBA组467例,使用RevMan　5.0软件进行Meta分析。结果　在治疗冠状动脉支架内再狭窄时,CBA组即刻弹性回缩低于POBA组,二者之间有统计学意义（MD：－0.52,95%CI：-0.76～－0.29,P<0.0001）;弹性回缩率CBA组明显低于POBA组,两组间存在统计学意义（MD：－13.83,95%CI：－16.17～－11.49,P<0.00001）。球囊扩张后冠状动脉直径狭窄度POBA组大于CBA组,两组间有统计学意义（MD：－12.99,95%CI：－18.09～－7.88,P<0.00001）。晚期丢失血管内径CBA组低于POBA组,两组存在统计学意义（MD：－13.83,95%CI：－0.50～－0.28,P<0.00001）。6个月后随访支架内再狭窄率POBA组明显高于CBA组,二者间有统计学意义（MD：0.44,95%CI：0.44,10.24,0.80,P<0.00001）。结论　CBA治疗冠状动脉支架内再狭窄更加安全有效。     

冠状动脉支架内再狭窄切割球囊成形术在老年患者中的应用

目的观察冠状动脉支架内再狭窄切割球囊成形术在老年冠脉支架术后再狭窄中的应用效果。方法回顾性分析60例老年冠脉支架术后再狭窄患者临床资料,采用随机数字表法将其分为观察组和对照组,每组30例,对照组行普通球囊血管成形术,观察组行切割球囊成形术,对比两组球囊扩张后即刻弹性回缩率、血管最小直径和狭窄程度、管腔丢失和再狭窄发生。结果两组均成功顺利完成球囊血管成形术,手术成功率为100.00%,观察组球囊扩张后即刻弹性回缩率〔(6.28±2.65)%〕明显小于对照组〔(20.08±12.56)%〕(P0.05);观察组术后即刻、随访各时刻血管最小直径均明显大于对照组,血管狭窄程度均明显小于对照组(P0.05);观察组随访3、6、12个月管腔直径丢失明显小于对照组(P0.05);观察组再狭窄率(16.67%)明显低于对照组(40.00%)(P0.05)。结论冠状动脉支架内再狭窄老年患者行切割球囊成形术手术成功率高,术后即刻弹性回缩率低,血管扩张效果明确,再狭窄率低,可作为首选的球囊扩张方案之一。     

经皮冠状动脉腔内切割球囊成形术治疗小血管病变的临床评价

冠状动脉支架置人术（Stenting）治疗直径大于3mm的冠脉m管病变可明确降低再狭窄发生率，但对于小血管（直径〈3mm）的冠脉病变介入治疗方式仍有争论。本文旨在通过应用经皮冠状动脉腔内切割球囊成形术（Cutting Balloon Angioplasty，CBA）和普通球囊血管成形术（Plain Old Balloon Angioplasty．POBA）的比较，探讨CBA对冠心病小血管病变的疗效。     

经皮切割球囊成形术治疗支架内再狭窄的研究

目的　研究切割球囊成形术对治疗支架内再狭窄的即刻和 6个月内随访效果。方法　 6 9例支架内再狭窄患者随机分配到切割球囊组 (38例 )和普通球囊治疗组 (31例 )。球囊扩张前及扩张后即刻在定量冠状动脉造影和冠状动脉内超声下 ,测定相关参数。观察随访 6个月内临床改善及冠状动脉造影结果。研究终点包括出现心肌梗死 ,需要冠状动脉搭桥或再介入治疗。结果　两组的手术成功率均为 10 0 %。切割球囊组 1例患者扩张后在支架的远端出现夹层。平均随访 (6 .7± 2 .3)个月。切割球囊组于术后 3和 6个月时的再狭窄率显著低于普通球囊组(15 %∶38%及 18%∶4 2 % ,P <0 .0 0 1)。扩张后即刻血管直径获得值在切割球囊组和普通球囊组分别为 (1.72±0 .5 2 )mm和 (1.15± 0 .5 4 )mm ,随访 3个月及随访终点时切割球囊组的血管直径晚期丢失分别为 (0 .2 6± 0 .0 5 )mm(3个月 )及 (0 .38± 0 .0 6 )mm ,同时的普通球囊组丢失值分别为 (0 .78± 0 .19)mm(3个月 )及 (0 .89± 0 .16 )mm。结论　切割球囊成形术治疗老年冠心病患者支架内狭窄效果可靠 ,安全 ,容易操作 ,再狭窄率低     

不同预处理球囊在药物涂层球囊治疗冠状动脉病变中的临床应用效果比较

［摘要］　目的　比较不同预处理球囊在药物涂层球囊治疗冠状动脉病变中的临床应用效果。方法　招募2020年10月至2021年10月沧州市人民医院收治的冠心病心绞痛患者150例，采用随机数字表法将其分为非顺应性球囊组、棘突球囊组和切割球囊组，每组50例。在放置药物球囊治疗前分别给予非顺应性球囊、棘突球囊、切割球囊预处理。于术前、术后即刻，以及术后6个月、12个月分别行冠脉造影检查，比较三组介入治疗成功率、手术时间、球囊一次性通过率、弹性回缩率、病变血管最小内径、冠脉狭窄率、靶血管再狭窄，以及术后即刻心肌梗死溶栓治疗分级（TIMI）3级、血管夹层、紧急靶血管重建和主要心血管不良事件（MACE）发生情况。结果　切割球囊组术后即刻，以及术后6个月、12个月的介入治疗成功率高于非顺应性球囊组和棘突球囊组（P<0.017）。切割球囊组术后即刻TIMI 3级比例高于非顺应性球囊组和棘突球囊组（P<0.017）。切割球囊组弹性回缩率、血管夹层和紧急靶血管重建发生率均显著低于非顺应性球囊组（P<0.017或P<0.05），但切割球囊组球囊一次性通过率低于非顺应性球囊组和棘突球囊组（P<0.017），切割球囊组手术时间长于非顺应性球囊组和棘突球囊组（P<0.05）。三组术后病变血管最小内径逐渐减少，冠脉狭窄率逐渐增加，切割球囊组术后6个月、12个月的病变血管最小内径大于非顺应性球囊组和棘突球囊组，冠脉狭窄率低于非顺应性球囊组和棘突球囊组，差异有统计学意义（P<0.05）。切割球囊组靶血管再狭窄、MACE发生率显著低于非顺应性球囊组（P<0.017）。结论　与非顺应性球囊和棘突球囊比较，切割球囊预扩张可降低血管夹层发生率和弹性回缩率，提高冠脉介入治疗的即时效果并维持病变管腔通畅，降低靶血管再狭窄和MACE发生风险。     

球囊血管成形术治疗冠脉支架内再狭窄21例观察

目的　观察单纯采用球囊扩张血管成形术 (PTCA)方法治疗支架内再狭窄的近期疗效。方法　应用与支架直径相同的球囊行支架内扩张治疗 2 1例支架内再狭窄的病人 ,随访半年临床疗效。结果　治疗病变 2 8处。第 1次介入治疗前后血管内径分别为 ( 1 12± 0 71)mm∶( 3 12± 0 87)mm ,第 2次为 ( 0 91± 1 0 5 )mm∶( 3 0 1±0 82 )mm。 2次治疗后的支架内径无显著差别 (P >0 0 5 )。半年随访仅见 3处病变 ( 10 % )再次出现支架内狭窄。结论　单纯应用球囊扩张血管成形术治疗半年内发生的支架内再狭窄 ,可达到理想的临床疗效。     

经皮腔内β-射线放射疗法与切割球囊成形术联合治疗冠状动脉支架内再狭窄

目的　旨在研究经皮冠状动脉 (冠脉 )内 β 射线放射疗法 (β 放疗 ,Novoste)与切割球囊成形术 (CBA)联合治疗支架内再狭窄 (ISR)的疗效及其安全性。方法　冠脉内支架置入术后ISR >70 %的病人 2 95例 [男性 2 0 5例 ,女性 90例 ,年龄 (5 9 76± 10 83)岁 ],其中 112例均行CBA联合 β 放疗为 β 放疗组 (n =112 ) ,183例单独采用CBA(89例 )或普通球囊扩张成形术 (94例 )为对照组 (n =183)。弥漫性长病变ISR者β 放疗先照射病变远段 ,再回撤导管照射病变近段。所有病例术前、术后即刻及术后随访期行冠脉造影 ,分析病变长度、最小管腔直径 (MLD)、参照管腔直径 (RLD)和管腔直径狭窄百分比 (DS)。随访靶血管再次成形率 (TVR)和主要不良心血管事件 (MACE)发生率。结果　术前及术后即刻两组病人的冠脉造影结果差异无显著性。随访期 (6 3± 1 6月 ) β 放疗组的MLD大于对照组 ,DS小于对照组 ,P <0 0 5。β 放疗组与对照组的心绞痛、心肌梗死及死亡率相似 ,差异无显著性(心绞痛为 10 %vs17% ,心肌梗死为 1%vs 2 % ,死亡率为 0 %vs2 % ) ,但β 放疗组的TVR和MACE明显低于对照组 (TVR为 5 %vs 16 % ,MACE为 10 %vs 2 5 % ,P <0 0 5 )。β 放疗组 2 8例 (2 6 % ,2 8 10 6 )弥漫性长病变ISR ,回撤 β 放疗导管分     

不稳定型心绞痛患者血清白细胞介素-6、肌钙蛋白和C-反应蛋白在切割球囊血管成形术前后的变化

目的　比较切割球囊血管成形术 (CBA)与普通球囊血管成形术 (BA)对血清白细胞介素 (IL 6 )、肌钙蛋白 (cTnI)和C 反应蛋白 (CRP)浓度的影响。方法　选择 6 5例入院拟行冠状动脉介入治疗的不稳定型心绞痛患者 ,随机分为两组 ,分别接受CBA或BA (即CBA组和BA组 ) ,球囊扩张后均放置支架。采用ELESCA双抗体夹心法分别测定血清IL 6、cTnI和CRP的浓度。结果　两组患者靶病变情况无显著差异。CBA组的球囊最大充盈压和支架置入压力明显低于BA组(P <0 .0 1)。BA组IL 6浓度在术后即刻开始高于CBA组 (P <0 .0 5 ) ,术后 2h和 6h差异进一步增大 (P <0 .0 1)。BA组 2 4h的血清cTnI水平明显高于CBA组 (P <0 .0 5 )。BA组的CRP浓度在术后 6h、2 4h和 48h都明显高于CBA组 (P <0 .0 1)。结论　单纯CBA或其联合支架置入术对不稳定型心绞痛患者血清IL 6、cTnI和CRP浓度的影响均小于单纯BA或其联合支架置入术 ,这可能是前者通过减轻对炎症反应的影响 ,减少再狭窄及心血管事件发生的机制之一。     

Cutting balloon angioplasty for the treatment of in-stent restenosis in diabetics: A matched comparison of 6 months' outcome with conventional balloon angioplasty

Ranging from 24% to 55%, angiographic in-stent restenosis (ISR) rates in diabetics are higher than the 17% to 28% rates observed in nondiabetics. There are controversies regarding optimal treatment for ISR. Recently, cutting balloon angioplasty (CBA) emerged as a tool in management. The authors assessed the hypothesis that CBA has advantages over conventional percutaneous transluminal balloon angioplasty (PTCA) in treatment of ISR in diabetics. CBA or PTCA was applied to 165 diabetics (267 ISR lesions) in their institution. With a computer algorithm, an attempt was made to match each lesion in the CBA group with a corresponding lesion in the PTCA group. The lesion pairs should match with respect to the patients' age and gender, type of target vessel and stent, reference vessel diameter, and baseline minimal lumen diameter (MLD). Following the matching process, 55 ISR lesion pairs were identified. Baseline patient characteristics were similar among the groups (p = NS). There was no difference in the in-hospital major adverse cardiac events (MACE) between the groups, whereas MACE at follow up was significantly lower in the CBA group compared to the PTCA group (CBA, 20.0% vs PTCA, 43.6%, p<0.05). The recurrent ISR rate was significantly lower in the CBA group compared to the PTCA group (CBA, 27.3% vs PTCA, 49.1%; p < 0.05). Also, a diffuse pattern of recurrence was more common in lesions treated with PTCA, whereas a focal pattern of recurrence was more common in the CBA group. The minimal luminal diameter at follow-up, the acute gain, and net gain were significantly higher in the group of lesions treated with CBA than in the PTCA group. In addition, a significantly higher late loss and loss index at follow-up were observed in the PTCA group compared to the CBA group. CBA has advantages over PTCA in treatment of diabetic patients with ISR, with better immediate and follow-up angiographic outcomes, and better follow-up clinical outcome.     

Effectiveness of cutting balloon angioplasty for small vessels less than 3.0 mm in diameter

The aim of this study was to evaluate the effectiveness of cutting balloon angioplasty (CBA) in small vessels < 3.0 mm in diameter. Included were 166 patients (175 lesions) treated with CBA (CBA group), and 215 patients (240 lesions) were treated with plain old balloon angioplasty (POBA group). No differences were observed in patient backgrounds or lesion characteristics between the two groups. Procedural success rates were similar: 98.3% (CBA) versus 95.8% (POBA). Coronary dissection rates were also similar: 7.4% in the CBA versus 5.8% in the POBA group. Severe dissections (types E and F) occurred in 2.5% of cases in the POBA group, whereas there was none observed in the CBA group. In-hospital complications occurred in 3.3% in the POBA group, and in only 0.6% in the CBA group. The restenosis rate was 37.5% (CBA group) versus 48.1% (POBA group); and in vessels < 2.75 mm, restenosis was significantly lower in the CBA group than in the POBA group (36.9% vs 62.7%, P < 0.05). CBA may be a useful therapeutic strategy for small vessels, given the absence of severe coronary dissection and the significantly lower rate of restenosis compared to POBA.     

Cutting balloon angioplasty vs. conventional balloon angioplasty in patients receiving intracoronary brachytherapy for the treatment of in-stent restenosis.

The objective of this study was to evaluate the safety and efficacy of cutting balloon angioplasty (CBA) for the treatment of in-stent restenosis prior to intracoronary brachytherapy (ICB). Cutting balloon angioplasty may reduce the incidence of uncontrolled dissection requiring adjunctive stenting and may limit "melon seeding" and geographic miss in patients with in-stent restenosis who are subsequently treated with ICB. We performed a retrospective case-control analysis of 134 consecutive patients with in-stent restenosis who were treated with ICB preceded by either CBA or conventional balloon angioplasty. We identified 44 patients who underwent CBA and ICB, and 90 control patients who underwent conventional percutaneous transluminal coronary angioplasty (PTCA) and ICB for the treatment of in-stent restenosis. Adjunctive coronary stenting was performed in 13 patients (29.5%) in the CBA/ICB group and 41 patients (45.6%; P < 0.001) in the PTCA/ICB group. There was no difference in the injury length or active treatment (ICB) length. The procedural and angiographic success rates were similar in both groups. There were no statistically significant differences in the incidence of death, myocardial infarction, recurrent angina pectoris, subsequent target lumen revascularization, or the composite endpoint of all four clinical outcomes (P > 0.05). Despite sound theoretical reasons why CBA may be better than conventional balloon angioplasty for treatment of in-stent restenosis with ICB, and despite a reduction in the need for adjunctive coronary stenting, we were unable to identify differences in clinical outcome.     

Cutting balloon versus conventional balloon angioplasty for the treatment of in-stent restenosis: results of the restenosis cutting balloon evaluation trial (RESCUT)

OBJECTIVES: The aim of this trial was to compare cutting balloon angioplasty (CBA) with conventional balloon angioplasty (i.e., percutaneous transluminal coronary angioplasty [PTCA]) for the treatment of patients with coronary in-stent restenosis (ISR). BACKGROUND: Retrospective studies suggest CBA might be superior to conventional PTCA in the treatment of ISR. METHODS: The Restenosis Cutting Balloon Evaluation Trial (RESCUT) is a multicenter, randomized, prospective European trial including 428 patients with all types of ISR (e.g., focal, multifocal, diffuse, proliferative). RESULTS: In both groups, the majority of ISR lesions were shorter than 20 mm. The length of restenotic stents was similar (CBA: 18.6 +/- 9.7 mm; PTCA: 18.3 +/- 8.7 mm). The number of balloons used to treat ISR was lower in the CBA group: only one balloon was used in 82.3% of CBA cases, compared with 75% of PTCA procedures (p = 0.03). Balloon slippage was less frequent in the CBA group (CBA 6.5%, PTCA 25%; p < 0.01). There was a trend toward a lower need for additional stenting in the CBA group (CBA 3.9%, PTCA 8.0%; p = 0.07). At seven-month angiographic follow-up, the binary restenosis rate was not different between the groups (CBA 29.8%, PTCA 31.4%; p = 0.82), with a similar pattern of recurrent restenosis. Clinical events at seven months were also similar. CONCLUSIONS: Cutting balloon angioplasty did not reduce recurrent ISR and major adverse cardiac events, as compared with conventional PTCA. However, CBA was associated with some procedural advantages, such as use of fewer balloons, less requirement for additional stenting, and a lower incidence of balloon slippage.     

Cutting balloon angioplasty for the treatment of in-stent restenosis: a matched comparison with rotational atherectomy, additional stent implantation and balloon angioplasty

OBJECTIVES: The purpose of the study was to determine whether cutting balloon angioplasty (CBA) has advantages over other modalities in treatment of in-stent restenosis (ISR). BACKGROUND: Controversies exist regarding optimal treatment for ISR. Recently, CBA emerged as a tool in management of ISR. METHODS: A total of 648 lesions treated for ISR were divided into four groups according to the treatment strategy: CBA, rotational atherectomy (ROTA), additional stenting (STENT), and percutaneous transluminal coronary angioplasty (PTCA). Following the matching process, 258 lesions were entered into the analysis. RESULTS: Baseline clinical and angiographic characteristics were similar among the groups (p = NS). Acute lumen gain was significantly higher in the STENT group (2.12 +/- 0.7 mm), whereas in the CBA group the gain was similar to one achieved following ROTA and following PTCA (1.70 +/- 0.6 vs. 1.79 +/- 0.5 mm and 1.56 +/- 0.7 mm, respectively; p = NS). The lumen loss at follow-up was lower for the CBA versus ROTA and versus STENT (0.63 +/- 0.6 vs. 1.30 +/- 0.8 mm and 1.36 +/- 0.8 mm, respectively; p < 0.0001), yielding a lower recurrent restenosis rate (20% vs. 35.9% and 41.4%, respectively; p < 0.05). By multivariate analysis, CBA (odds ratio [OR] = 0.17; confidence interval [CI], 0.06 to 0.51; p = 0.001) and diffuse restenosis type at baseline (OR = 2.07; CI, 1.15 to 3.71; p = 0.02) were identified as predictors of target lesion revascularization. CONCLUSIONS: We conclude that CBA is a safe and efficient technique for treatment of ISR, with immediate results similar to atheroablation and better clinical and angiographic outcomes at follow-up. This approach might be implemented as a viable option in management of focal ISR and to prepare diffuse ISR for brachytherapy treatment.     

Contribution of early lumen loss after balloon angioplasty for in-stent restenosis to lumen loss at follow-up.

The treatment of in-stent restenosis using balloon angioplasty alone often produces excellent early results, but is associated with high rate of recurrence. Previous studies have demonstrated significant tissue reintrusion shortly after the treatment of in-stent restenosis with balloon angioplasty. The study was designed to elucidate the contribution of early lumen loss 6 hr after balloon angioplasty to lumen loss at follow-up. We prospectively performed quantitative coronary angiography and intravascular ultrasound in 12 patients with in-stent restenosis before intervention, after the final procedure, 6 hr later (5.6 +/- 1.4 hr), and at follow-up (7.7 +/- 2.3 months). Compared with immediately after balloon angioplasty, by 6 hr postintervention, the minimum lumen diameter (MLD) and lumen cross-sectional area had decreased significantly (2.48 +/- 0.44 to 2.01 +/- 0.57 mm, P = 0.01, and 7.0 +/- 1.2 to 5.5 +/- 1.4 mm2, P = 0.004, respectively). Furthermore, the MLD decreased further between 6 hr postintervention and long-term follow-up (2.01 +/- 0.57 to 1.55 +/- 0.64 mm; P = 0.001). Patients who showed recurrence of restenosis at follow-up had greater early lumen loss than patients without recurrence of restenosis (0.71 +/- 0.31 vs. 0.23 +/- 0.13 mm; P = 0.006). Diffuse lesions had greater early lumen loss compared to focal lesions (0.75 +/- 0.35 vs. 0.28 +/- 0.13 mm; P = 0.008). Early lumen loss is common after the treatment of in-stent restenosis by balloon angioplasty. Within the first 6 hr postintervention, 32% +/- 29% of acute lumen gain is lost, and early lumen loss contributed to 42% +/- 18% of total lumen loss at follow-up.     

Promising efficacy of primary gradual and prolonged balloon angioplasty in small coronary arteries: a randomized comparison with cutting balloon angioplasty and conventional balloon angioplasty

Background

Small vessel size represents a critical risk factor for an adverse outcome after both conventional balloon angioplasty (POBA) and stenting. Gradual and prolonged balloon angioplasty (GPBA) has been shown to cause less arterial trauma, which results in higher procedural success rates and fewer in-hospital complications than POBA. The aim of this study was to assess the clinical and angiographic benefits of primary GPBA with a perfusion balloon in small coronary arteries, as compared with cutting balloon angioplasty (CBA) and POBA.

Methods

A total of 263 patients with symptoms and reference diameters <3.0 mm were randomly assigned to undergo GPBA (n = 85), CBA (n = 88), or POBA (n = 90). The cumulative inflation time must be >10 minutes in GPBA. Crossover to stent was allowed for inadequate results. Follow-up angiography was performed after 6 months. The primary end point was angiographic restenosis at follow-up.

Results

Compared with POBA, GPBA resulted in a lower final residual diameter stenosis (27.3% vs 34.2%, P = .01) and decreased the need for stent placement (8.0% vs 22.2%, P = .031). At follow-up, the restenosis rates were lower with GPBA (31.3%, P = .034) and CBA (32.9%, P = .059) than POBA (50.6%). Target lesion revascularization was less frequently needed with GPBA (20.5%, P = .043) and CBA (20.0%, P = .033) than POBA (37.6%). Additionally, the event-free survival rate was higher with GPBA (77.1%, P = .033) and CBA (76.4%, P = .047) than POBA (58.8%).

Conclusions

In small coronary arteries, both GPBA and CBA resulted in favorable angiographic and clinical outcomes. With a lower restenosis rate and target lesion revascularization rate, GPBA may be a superior strategy for small vessels compared with POBA.     

Immediate and 3-month follow-up outcome after cutting balloon angioplasty for bifurcation lesions

Balloon angioplasty of a bifurcation lesion is associated with lower rates of success and higher rates of complications than such treatment of lesions of most other morphologies. To date, the best device or procedure for bifurcation lesions has not been determined. The aim of this study was to compare the immediate and 3-month follow-up outcome of cutting balloon angioplasty (CBA) versus conventional balloon angioplasty (PTCA) for the treatment of bifurcation lesions. We treated 87 consecutive bifurcation lesions with CBA (n = 50) or PTCA (n = 37). Paired angiograms were analyzed by quantitative angiography, and angiographic follow-up was achieved for 93% of the lesions. The procedural success was 92% in the CBA group and 76% in the PTCA group (P < 0.05). Major in-hospital complications occurred in two lesions in the CBA group and six in the PTCA group (P = 0.05). The incidence of bail-out stenting in the CBA group was lower than in the conventional PTCA (8% vs 24%, P < 0.05). At the 3-month follow-up, the restenosis rate was 40% in the CBA group versus 67% in the PTCA group (P < 0.05). Clinical events during follow-up did not differ between the two groups. In conclusion, in comparison with PTCA, procedural success was greater and the restenosis rate lower with CBA. The results of this study support the use of the cutting balloon as optimal treatment for bifurcation lesions. (J Interven Cardiol 2004;17:1–7)     

Efficacy of cutting balloon angioplasty for in-stent restenosis: an intravascular ultrasound evaluation

BACKGROUND: The increase in the use of stents has seen the increasing emergence of in-stent restenosis (ISR). Reports suggest that the Cutting Balloon (Interventional Technologies, San Diego, California) may be a useful treatment modality for this new clinical entity. METHODS: In this study, we compared the efficacy of Cutting Balloon angioplasty (CBA) with conventional balloon angioplasty (PTCA) for ISR in 47 patients (47 lesions). Results were evaluated with intravascular ultrasound (IVUS). The CBA group included 25 patients (mean age, 65 +/- 78 years; 7 females) and the PTCA group included 22 patients (mean age, 69 +/- 51 years; 6 females). RESULTS: The procedural success rate was 100% in both groups. IVUS showed that luminal area acute gain was larger in the CBA group (2.5 +/- 0.8 mm2) compared to the PTCA group (1.8 +/- 1.0 mm2), while late loss was smaller in the CBA group (0.5 +/- 0.4 mm2) compared to the PTCA group (1.3 +/- 0.5 mm2). The change in total area was similar in both groups. The increase in area at the stented portion was 0.4 +/- 0.8 mm2 in the CBA group and 1.2 +/- 0.5 mm2 in the PTCA group. The restenosis rate at follow-up (mean follow-up, 5.4 months) was higher in PTCA patients (59%) than in the CBA patients (24%). CONCLUSION: CBA may result in no increase in total vessel area, a constant stent area, a decrease in plaque area, and an increase in lumen area (induced by the decrease in plaque area). Our IVUS findings suggest that compared to PTCA, the dilatation mechanism of CBA may be associated with reduced dilatation of both the total vessel area and the stent area for ISR. The mechanism of this modality may minimize injury to the intimal membrane and may potentially be a primary device for in-stent restenosis in the future.     

Safety and efficacy of cutting balloon angioplasty: the Mayo Clinic experience

A number of evolving clinical indications for cutting balloon angioplasty (CBA) have been described in the clinical literature, including angioplasty-resistant stenoses, in-stent restenosis, ostial lesions and small vessel disease. METHODS: We analyzed the Mayo Clinic PTCA registry and report procedural and in-hospital clinical outcomes in 100 patients (103 procedures, 114 lesions) undergoing CBA. RESULTS: CBA was successfully completed in 109 lesions (96%). The majority of lesions (73%) required additional treatment with either balloon angioplasty (39%) or stent implantation (34%). Severe intimal dissection resulting in at least 50% luminal obstruction occurred in 13 lesions (11%). A single incident of branch occlusion was documented, resulting in ST elevation myocardial infarction. There were no incidents of vessel perforation, urgent percutaneous or surgical target vessel revascularization, or in-hospital death. CONCLUSION: CBA is feasible and safe, with a low incidence of procedural complications and in-hospital adverse cardiac events when used primarily for in-stent restenosis.